The ways in which stigma can affect individual and public health is illustrated by the example presented by Henning and Nair. In addition to being a matter of human rights and justice, access to care is also important for public health. In other cases, the provision of medical care to individual patients may itself have adverse effects on public health.
Case Description
As a result of the letter, the parents of 137 children take the vaccine booklet to school, which shows a low level of measles vaccine coverage (60). The next day, the measles outbreak at the school comes to the attention of the local and national media.
Discussion Questions
- Background
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- Discussion Questions
Mother-to-child transmission (MTCT)—also known as vertical transmission—is the leading cause of HIV infection in children under 10 years of age (Interagency Coalition on AIDS and Development 2011). It is associated with a lower risk of various health problems. for infants, including reducing the risk of death from diarrhea and malnutrition (World Health Organization 2007; O'Reilly et al. 2012. However, the risk of an HIV-positive woman passing the virus to her child in the absence of intervention ranges from 15 to 45% (De Cock et al. 2000; World Health Organization 2015.
Avoidance of breastfeeding (use of substitute feeding) reduces the risk of neonatal transmission to 20% (Interagency Coalition on AIDS and Development 2011. Modified feeding, also known as mixed feeding (liquids or solids) results in a risk of transmission of approximately 30-35% (Coutsoudis et al. 1999. In many countries, social stigma, fear of the risk of discrimination, rejection, and violence can prevent a woman's intention to get tested for HIV, take antiretroviral drugs, or replace breast milk (Interagency Coalition on AIDS and Development 2011.
What procedures can he implement to reduce the risk of HIV positive women being stigmatized by their partners, family or community. Influence of infant feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study.
- Background
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NBS is performed in nearly 100% of the newborn population in North America, roughly four million babies per year in the United States (Botkin et al. 2012). In contrast, an important goal of the public health service model is to inform decision-making or avoid a “diagnostic odyssey” (Bailey et al. As the manager of a newborn screening program, you are responsible for the day-to-day operation of the program, as well as risk and resource management, program evaluation and quality improvement initiatives.
In light of increasing media and researcher interest, as well as political pressure, the Department of Health has asked the Standing Advisory Committee on Newborn Screening to convene a task force to review your jurisdiction's policy regarding the retention of newborn blood spots and the information provided to parents. You are aware of the potential conflict between public health benefits and parental consent for the secondary use of blood spots for research. Exploring existing and considered community perspectives on newborn screening: informing the development of state and national policy standards for newborn screening and the use of dried blood stains.
Newborn screening programs: How best to protect privacy rights while ensuring optimal newborn health. Use of newborn screening program blood spots to assess exposure: declining levels of perfluorinated compounds in New York State infants.
- Background
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The program provided cash incentives to women who gave birth in health facilities and to health care providers for each attendance at the birth (either in the woman's home or in a facility). The program was most effective in changing health care-seeking behavior wherever women's groups highlighted the importance of effective communication of the policy to the public (Powell-Jackson et al. 2008. Overall, the program was well received, although certain aspects of the policy were not accepted, including a condition that limited receipt of the cash incentive to women who had no more than two living children (Powell-Jackson et al. 2008.
India's conditional cash transfer program Janani Suraksha Yojana (JSY) is one of the largest programs of its kind in the world (Lim et al. 2010. One of the goals of JSY, in addition to coverage, is equity; the JSY program does not include private health providers. Increasing births (from 35 to 65%) in public health institutions can raise questions in the quality and standards of health care (MacDonald 2011.
Who are the key stakeholders in the case of the 19-year-old woman and what values and cultural perspectives does each stakeholder bring to this situation. The Impact of Nepal's National Incentive Program to Promote Safe Delivery in Makwanpur District.
- Background
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For others, prostitution is inherently exploitative, with all commercial sex workers being victims who lack legal (ie alternative) forms of employment. The 35th anniversary of the International Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) provides an opportunity for governments to affirm that expanding HIV services to commercial sex workers and promoting public health are not mutually exclusive efforts. So you eagerly embark on an intervention program encouraging commercial sex workers to get tested for HIV.
You consider all of these issues as you consider how you can start an intervention program for commercial sex workers to encourage them to get tested for HIV. How should the criminal nature of commercial sex work affect the intervention you develop to encourage commercial sex workers to get tested for HIV? Should the public health department monitor the incidence of HIV among commercial sex workers?
Do you think ratification of international laws such as CEDAW can improve the health of commercial sex workers? A common CD4 gene variant is associated with an increased risk of HIV-1 infection in Kenyan female commercial sex workers.
- Background
- Case Description
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A terrorist group has released an anthrax aerosol over a major US city and in a country with a weak public health infrastructure. It is unclear what plans have been made to provide prophylaxis to the population living in the other country. In the United States, people believed to be exposed will receive antibiotics and vaccine at points of dispensing (PODs) operated by local health departments.
In the United States, children who need a vaccine come to the vaccination clinic with their parents, slowing down lines to meet informed consent requirements. Discuss the informed consent document with a group of families, answering questions and addressing concerns about risks and benefits in the larger group, but have a nurse present to answer confidential questions and talk privately with families. Have a large group of families, gathered in an auditorium, watch a video produced by the local health department explaining the vaccine's safety and efficacy profile in adults, then have a nurse share the information from the informed consent document with the parents discuss and let parents ask questions.
What role will government credibility and public trust in government play in the vaccination campaign. Anthrax vaccine use in the United States: Advisory Committee on Immunization Practices (ACIP) recommendations, 2009.
- Background
- Case Description
- Discussion Questions
In October 2009, he moved to the northern part of the country to work as a driver and gave up treatment for the first time. However, after five attempts over 3 years, Pedro was unable to complete the daily phase of treatment. Because of his previous medical history, he was now referred to a specialist center where the doctor in charge of the tuberculosis program assessed his case and wrote in his medical record: “The patient does not seem to understand his situation and the risk he poses to his family … it seems to me that the medical staff is more concerned about the patient's illness than the patient himself.” The specialist concluded that it was unlikely that the patient would complete the treatment after six failures.
Disciplinary discharge would be more appropriate for this patient," the doctor added, "especially given the high demand for hospital care." Despite the earlier decision of the doctor in charge of the tuberculosis program, the doctors reassess the case and decide that he should receive further treatment for tuberculosis. Do you agree with the doctors' decision to allow the patient to continue treatment for tuberculosis?
In view of the risk that the patient could infect his family with TB, he would be refused further treatment or given another chance to complete it. When a patient can transmit a serious infectious disease, there must be legal enforcement of the requirement to be treated.
- Background
- Case Description
- Discussion Questions
Given limited time, resources, and personnel, those requiring evacuation assistance will need to be categorized by method of evacuation (eg, medevac, ambulance, bus) and the order in which they will be evacuated. Those who do not comply with evacuation orders raise the question of whether they should be forced to evacuate and whether first responders have a moral obligation to go back and rescue them. Special needs and vulnerable populations (eg disabled, sick and injured, homeless and incarcerated) will also need help evacuating.
Some of those who cannot evacuate will be able to stay with friends or family. What are the relevant ethical considerations in deciding who should be evacuated first and whether an evacuation order should be mandatory or voluntary. How to make decisions about who to evacuate when not everyone can be evacuated.
Do the authorities have obligations towards people who refuse to evacuate and need to be rescued later? Should people who had the option to evacuate, but did not do so, somehow be blamed or punished if they later need to be rescued.
